Provider Demographics
NPI:1982618906
Name:BAKER, WALTER GARY (MED,LMSW,LPC,CAC-1)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:GARY
Last Name:BAKER
Suffix:
Gender:M
Credentials:MED,LMSW,LPC,CAC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24225 W 9 MILE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-3990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24225 W 9 MILE RD STE 114
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-3990
Practice Address - Country:US
Practice Address - Phone:248-352-8841
Practice Address - Fax:248-352-8180
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-00432101YA0400X
MI6401007535101YP2500X
MI68010462171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical